S 1st A ikkim Amat ll India Ope eur Mounta APPLICATI n Artificial B

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S 1st A ikkim Amat ll India Ope eur Mounta APPLICATI n Artificial B
 Sikkim Amateur Mountaaineering Association (SSAMA) APPLICATIION FORM FFOR 1st All India Open Artificial B
Bouldering C
Competition
n in Sikkim 12/05/2015
5 to 15/05/2
2015 Topic : Venue : D
Duration : 1. Name (In Blocks Lettters) : ___
____________________________________ 2. Fatherr’s Name : ___
____________________________________ 3. Residen
ntial Address (with telepho
one, Fax
: _______________________________________ email if an
ny in block lettters) _______________________________________ _______________________________________ ___
____________________________________ of Birth (Photo
ocopy of evid
dence) 4. Date o
: ___
____________________________________ 5. Association / Club rrepresented &
& : ___
____________________________________ one, fax, emaiil if any)
address ((with telepho
___
____________________________________ ___
____________________________________ 6. Next o
of Kin & Relationship 7. Climbin
ng experience
e : (Use sepaarate sheets iff space is not enough)
ory (SC/ST/OB
BC/Gen/NEC)) 8. Catego
: _______________________________________ _______________________________________ ___
____________________________________ : 9. Open (m
man, woman) Junior (Boyss, Girls) ___
____________________________________ ________________________________________ : ___________________________
_____________ DECLARATION a) I agree to adhere strictly to the discipline of the programme and abide by the directions of the organizers or their nominees, at all times during programme. b) In case of any accident, illness or injury, I will not hold the organizers wholly or partly responsible. c) I declare that I have not been in contact with any infectious disease for the past one month and that I am keeping good health. _____________________ ______________________ Signature of Parent / Guardian Signature of Participant (in case of minor participant) Date: Place: NB: The said competition will be conducted for Bouldering climbing as per Rules of international federation of sport Climbing (IFSC) for the following categories. Equipments: Climbers have to bring their own climbing shoes & chalk bag. The other necessary equipments will be provided by the organizer. Application checked & verified by: In charge Sports Climbing Other detail in our www.sama.org.in Fees : Rs.500/‐ Dear Participant, SAMA will be conducting an 1st All India Open Artificial Bouldering Competition Sikkim 2015 will be held from 12.05.2015 to 15.05.2015 at the Palzor stadium. Organized by SIKKIM AMATEUR MOUNTAINEERING ASSOCIATION (SAMA). You are hereby cordially invited to send your climbers to participate in this competition. The competition will be conducted for Bouldering Climbing as per rules of International Federation of Sport Climbing (IFSC) for the following categories: 1. Junior (Boys & Girls) ‐ Under 16 years of age. 2. Open (Men & Women) ‐ 17 years & above. Participation: Participation fee is Rs. 500/‐ per participant. Age Proof certificate should be enclosed for junior participants. No transport or daily allowances (TA/DA) will provided by the organizers. Equipments: Climbers have to bring their own climbing shoes and chalk bag. Other necessary equipments will be provided by the organizers. Certificates: Certificates will be given to all the climbers. Yours truly, Sd/‐ (Kunzang Gyatso Everester) President : 9775921217 B.Namgyal – Gen. Secretary Ph.9434010330 Bhaichung Youzon – Info. Secretary Ph. 9733326213 

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